Risk Adjustment Coding Auditor

Location:

Dallas, Texas, United States Salary: $32.00 - $37.00/hr Company: TEKsystems

Posted:
Description Risk Adjustment Coding Auditor The Risk Adjustment Coding Auditor ensures the accuracy and completeness of coded clinical data to support compliant reporting and appropriate reimbursement across risk adjustment programs. The role strengthens organizational performance by identifying coding and documentation gaps, mitigating financial and regulatory risk, and improving data integrity. It provides subject matter expertise to support consistent application of coding standards and enables informed decision-making across the enterprise.

Your Responsibilities Evaluates risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practices

Protects patient records and audit information by ensuring compliance with HIPAA, privacy, security, and regulatory requirements

Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting

Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider‑reported diagnosis codes based on medical record documentation

Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories

Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements

Contributes to audit and production efforts to meet business demand and workload priorities

Provide written and verbal guidance on coding errors to others

Meets audit deliverables within established timelines and deadlines

Assists with special projects such as risk mitigation reviews

Serves as subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment

Skills

Audit, CRC, Coding, Risk Adjustment, Health Insurance Top Skills Details Audit,CRC,Coding,Risk Adjustment,Health Insurance Additional

Skills & Qualifications Required skills and experiences7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
5+ years of HCC coding experience in utilizing inpatient and outpatient coding guidelines5+ years of experience auditing Risk Adjustment records1+ years working in a Production environmentCRC (Certified Risk Coder) in good standing

Intermediate level of knowledge in risk adjustment Medicare, ACA Commercial and Medicaid models

Demonstrated ability to apply critical thinking skills to coding policy interpretation and implementation.

Experience providing written and verbal guidance on coding errors and trends

Intermediate (or higher) MS Office (Word, Excel, Powerpoint & Outlook)
Excellent organizational ability to manage multiple projects and perform in a deadline driven environment

High school diploma (or equivalency) and legal authorization to work in the U.S.Preferred skills and experiences

Bachelor’s degreeHEDIS/STARS experience

Provider education experience

Prior RADV experienceCPMA or other coding credentialsNLP Software experience Could possibly look at someone with RHIT or RHIA paired with the right coding expeirence.

Experience Level Intermediate Level Job Type & Location This is a Contract position based out of Dallas, TX.Pay and Benefits The pay range for this position is $32.00 - $37.00/hr individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be…